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Reduced Modulation of Pain in Older Adults Following Isometric and Aerobic Exercise

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Reduced Modulation of Pain in Older Adults Following Isometric and Aerobic Exercise HHS Public Access Author manuscript Author ManuscriptAuthor Manuscript Author J Pain. Author Manuscript Author manuscript; Manuscript Author available in PMC 2017 June 01. Published in final edited form as: J Pain. 2016 June ; 17(6): 719–728. doi:10.1016/j.jpain.2016.02.013. Reduced modulation of pain in older adults following isometric and aerobic exercise Kelly M. Nauglea, Keith E. Naugleb, and Joseph L. Riley IIIa Keith E. Naugle: [email protected] aPain Research and Intervention Center of Excellence College of Dentistry University of Florida P.O. Box 103628 Gainesville, FL, USA 32611 bDepartment of Kinesiology Indiana University Purdue University Indianapolis 901 West New York St. Indianapolis, IN , USA 46202 Abstract Laboratory based studies show that acute aerobic and isometric exercise reduces sensitivity to painful stimuli in young healthy individuals, indicative of a hypoalgesic response. However, little is known regarding the effect of aging on exercise-induced hypoalgesia (EIH). The purpose of this study was to examine age differences in EIH following submaximal isometric exercise, and moderate and vigorous aerobic exercise. Healthy older and younger adults completed one training session and four testing sessions consisting of either a submaximal isometric handgrip exercise, vigorous or moderate intensity stationary cycling, or quiet rest (control). The following measures were taken pre and post exercise/quiet rest: 1) pressure pain thresholds (PPTs), 2) suprathreshold pressure pain ratings, 3) pain ratings during 30-s of prolonged noxious heat stimulation, and 3) temporal summation of heat pain. The results revealed age differences in EIH following isometric and aerobic exercise, with younger adults experiencing greater EIH compared to older adults. The age differences in EIH varied across pain induction techniques and exercise type. These results provide evidence for abnormal pain modulation following acute exercise in older adults. PERSPECTIVE—This article enhances our understanding of the influence of a single bout of exercise on pain sensitivity and perception in healthy older compared to younger adults. This knowledge could potentially help clinicians optimize exercise as a method of pain management. Keywords Exercise-induced hypoalgesia; Aging; Pain modulation; Acute exercise; Exercise analgesia Corresponding Author: Present Address: Dr. Kelly M. Naugle, Department of Kinesiology, Indiana University Purdue University Indianapolis, 901 West New York St., Indianapolis, IN 46202, [email protected] Phone: 317-274-0601. Conflicts of Interest: There are no other conflicts of interest to report with regard to this work for any of the authors. Disclosures: This research was supported by NIH-NIA Grant R01AG039659 (J.L.R.) and NIH Grant T32 T32NS045551-06 (K.M.N.). Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Naugle et al. Page 2 Author ManuscriptAuthor INTRODUCTION Manuscript Author Manuscript Author Manuscript Author The burden of chronic pain among older adults is substantial with up to 60% of older adults reporting chronic pain in large community based samples.34,40 Pain is one of the primary causes of physical disability17, significantly impacts quality of life39, and dramatically increases individual and national health care costs.8 Substantial evidence supports the use of exercise as an effective tool to reduce pain and it is often recommended as an adjunct therapy in the treatment of chronic pain.7,13,14,19,45 Indeed, evidence from clinical trials suggests regular exercise can reduce pain symptoms in chronic pain conditions affecting older adults.7,19,45 Additionally, a single bout of exercise influences the experience of pain. In healthy young adults, acute aerobic and isometric exercise temporarily reduces pain sensitivity, a phenomenon termed exercise-induced hypoalgesia (EIH).30 However, many individuals with chronic pain (i.e., fibromyalgia, neuropathic pain) don’t experience EIH, and pain sensitivity and perception is often temporarily exacerbated following acute exercise.16,20,23,44,47 As regular exercise becomes an important component of the multidisciplinary treatment recommended for persistent pain in older adults, a comprehensive understanding of how acute exercise influences pain perception in this age group is important to optimize exercise as a method of pain management. The experience of pain is modulated by complex endogenous systems that both facilitate and inhibit pain.43 Substantial evidence from psychophysical tests (i.e., condition pain modulation (CPM), offset analgesia) indicates that dysfunction of pain inhibitory systems increases with age.5,24,28,38 A recent study revealed that endogenous pain inhibitory capacity, as evidenced on the CPM test, predicted the magnitude of pain reduction following acute isometric exercise.26 Thus, participants that demonstrated a poor pain inhibitory capacity were more likely to experience a hyperalgesic response following isometric exercise. Despite this evidence, little research has explored changes in pain sensitivity and perception following acute exercise in healthy older adults, a cohort that typically exhibits poor pain inhibitory capacity. One of the only studies to date addressing this topic, investigated the effect of isometric contractions that varied in intensity and duration on pressure pain perception in older and younger adults.25 Both older and younger adults exhibited reductions in pain following the isometric contractions; however, the EIH effect was smaller in older adults. To the best of our knowledge, no studies have examined EIH following aerobic exercise in older adults. The primary purpose of the current study was to examine age differences in EIH following submaximal isometric exercise, and moderate and vigorous aerobic exercise. Several studies have shown that experimental pain measures correlate only moderately across stimulus modalities and tests11,33; thus, we tested for EIH using a multimodal pain assessment. We assessed changes in threshold and suprathreshold pressure pain, temporal summation of pain, and pain perception during a prolonged heat pain test before and immediately after exercise. These pain measures likely represent distinct dimensions of pain perception that may be under the influence of different mechanisms.11 We hypothesized that EIH would be reduced in older compared to younger adults across all forms of acute exercise and pain tests. J Pain. Author manuscript; available in PMC 2017 June 01. Naugle et al. Page 3 Author ManuscriptAuthor METHODS Manuscript Author Manuscript Author Manuscript Author Participants Participants were twenty-five (age range: 19–30; average age=21.7±4.1 years; 14 females) healthy young adults and eighteen (age range: 55–74; average age=63.7±6.6; 9 females) older adults. Studies show that adults 55 years and older have reduced capacity for pain inhibition29,38; therefore, we are including adults 55 years and older in our older adult group. The younger group included 16 Caucasians, 3 Asian Americans, and 6 Hispanic Americans. The older group included 15 Caucasians, 1 Asian American, and 2 Hispanic Americans. Detailed results of the data on the younger adults has been previously published.31,32 A power analysis using G Power 3.1.5 was used to estimate the sample size needed for detecting a session by age group interaction for the outcome measures in a mixed model design. With the significance level set at 0.05, power at 0.80, a 0.5 correlation among repeated measures, and the effect size for differences between groups estimated to be moderate, the power analyses determined that a total of 34 participants (17 per group) would yield a power of 0.81. Participants were recruited through posted advertisements in the local community. Exclusion criteria included: 1) current use of narcotics or tobacco products, 2) uncontrolled hypertension, 3) neurological disease with significant changes in somatosensory and pain perception at intended stimulation sites, 4) the known presence of or any signs or symptoms of cardiovascular disease, pulmonary disease, or metabolic disease, 5) serious psychiatric conditions (e.g., schizophrenia and bipolar disorder), and 6) current use of opioids. Younger adults were excluded if they were not physically ready to exercise without a medical exam as indicated by the Physical Activity Readiness Questionnaire (PAR-Q).41 Older adults had to obtain physician approval from their primary care physician to participate in the study. During the health history interview, no participants indicated they were regularly taking pain medications or reported chronic pain. Session exclusion criteria included active infectious disease or febrile condition (e.g., sinusitis, influenza), severe uncontrolled hypertension, use of caffeinated drinks, or any pain medications prior to the experimental sessions. Procedures The University’s Institutional Review Board (IRB) approved all procedures and participants signed an IRB-approved informed consent form. Participants completed a screening/training session followed by four randomized experimental
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